Co-occurring substance dependence and posttraumatic stress disorder among incarcerated men

Abstract

The co-occurrence of substance use disorders (SUDs) and posttraumatic stress disorder (PTSD) is prevalent among inmates and is associated with numerous adverse outcomes. The present study sought to estimate the prevalence and patterns of co-occurring PTSD among substance-dependent inmates. Structured diagnostic assessment interview data from 176 adult male inmates incarcerated in a local jail facility were analyzed to assess study aims. Alcohol dependence was the most prevalent SUD with 81.3% of the total sample meeting current Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR) criteria. The remaining substance dependence diagnoses that predominated were as follows: cocaine, 35.2%; marijuana, 21.0%; heroin, 15.5%; and stimulant, 6.8%. Over half (54.6%) met diagnostic criteria for PTSD. A bimodal distribution was found for the PTSD cases as inmates tended to report either no symptoms or sub-diagnostic indications (45.4%), or acknowledge sufficient information to substantiate a severe diagnostic grouping (41.5%). Bivariate correlations between the symptom count for PTSD and the seven dependence criteria for the various substance dependence categories revealed several significant findings. Of particular interest were the negative correlations of alcohol dependence symptoms with those of cocaine (r = −.230, p < .01) and heroin (r = −.176, p < .05). PTSD severity was associated with higher symptom counts for marijuana (r = .244, p < .01) and cocaine (r = .233, p < .01) dependence. The design and implementation of SUD treatment programs for inmates must consider other co-occurring mental health issues as well and incorporate treatment techniques that address the symptoms associated with PTSD.

Keywords:

• co-occurring disorders
• substance dependence
• posttraumatic stress disorder
• jail inmates
• prevalence
• dual diagnosis

Acknowledgments

The author wishes to acknowledge Norm Hoffmann, Ph.D., for his role as primary mentor as he provided supervision and support on this project.